Endoscopic harvesting of vessels is well known in the surgical field and has been the subject of a great deal of recent technological advancement. Typically, the harvesting of vessels is performed so that the vessels can be then used for procedures such as Coronary Artery Bypass Grafting (CABG). In this procedure the saphenous veins of the legs are harvested for subsequent use in the CABG surgery. Vessel harvesting involves liberating the vessel from surrounding tissue and transecting smaller side branches, tying or ligating the vessel at a proximal site and a distal site, and then transecting the vessel at both sites before it is removed from the body.
Known endoscopic methods and devices for performing vessel harvesting are discussed in detail in U.S. Pat. No. 6,176,895 to Chin, et al., Re 36,043 to Knighton, U.S. Pat. No. 6,406,425 to Chin, et al., and U.S. Pat. No. 6,471,638 to Chang, et al., all of which are expressly incorporated herein by reference. Furthermore, various devices and methods disclosed in U.S. Pat. No. 5,895,353 to Lunsford, et al., and U.S. Pat. No. 6,162,173 to Chin, et al., and pending patent application Ser. No. 10/602,490 entitled “Apparatus and Method for Integrated Vessel Ligator and Transector” are also expressly incorporated herein by reference. Also, commercial vessel harvesting systems sold under the tradename VASOVIEW® 4 and VASOVIEW® 5 are available from Guidant Corporation of Santa Clara, Calif.
A first step in a known endoscopic method for removal of a vessel section is shown in FIGS. 1A and 1B using an optical vessel dissector 10, such as the CLEARGLIDE™ Optical Vessel Dissector sold by Ethicon, Inc. of Somerville, New Jersey, a subsidiary of Johnson & Johnson. The optical vessel dissector 10 is used to create an operative cavity in extraperitoneal spaces such as the retroperitoneal, preperitoneal, and subcutaneous areas, in particular surrounding vessels to be harvested. The optical vessel dissector 10 includes a cannula 12, a handle 14, and a transparent, blunt tip 16 that dissects tissue and creates a cavity for passage of the cannula 12. The device is used in conjunction with a separate endoscope for visualization through the tip during insertion, tunneling, and dissection.
Initially an incision I is made and the vessel V is located, for example the saphenous vein as illustrated. The vessel V is then dissected from the surrounding tissue using the leading edge of the optical vessel dissector 10 to separate the tissue from the vessel V, while being careful to avoid avulsion of side branches SB. At this time sufficient space is created around the vessel V so that other specific-function tools can be inserted into the incision I via lumen(s) or guides associated with the dissector 10. These tools include vessel transectors for performing a more complete severing of the vessel V which is to be removed. Severing/transecting tools (e.g., laparoscopic scissors) transect both the side branch vessels SB and the vessel V which is to be removed. Cauterizing/ligation tools (e.g., bipolar scissors) secure or close off both the side branch vessels SB and the vessel V which is to be removed. Another ligation method involves the use of a long, endoscopic clip applier that positions and applies clips at the proximal and distal ends of the vessel. Some tools perform both transection and ligation or cauterization. Ultimately, the vessel V is freed from surrounding tissue and side branches and can be transected at a desired length and removed from the cavity, sometimes within the cannula 12. The procedure may require a second incision at a distance from the first incision I to facilitate the final transection.
In some prior art systems for performing vessel harvesting, the various tools to be used to separate surrounding tissue from the vessel and sever and ligate or otherwise close off side branches are all separately provided and inserted through or alongside a primary endoscopic cannula. Each of the tools must be manipulated from a proximal end outside the body, which can be relatively cumbersome and complicated, especially since each of those tools usually has its own handle on the proximal end which in operation is placed within the same general space where the proximal handle of the primary endoscopic cannula is located. For example, FIGS. 3, 11, and 12 of U.S. Pat. No. 5,928,138 to Knight, et al. illustrate a separate ligating device 40 and cutting device 50 that are inserted into a subcutaneous cavity adjacent to a dissecting device and have separate handles for proximal manipulation. To rotate the distal tips of these devices, the entire handles must be rotated, typically by a second hand of the surgeon. This manipulation in a potentially crowded space may add difficulty to the procedure, somewhat like dueling swords.
Despite accepted endoscopic vessel harvesting systems and techniques, there remains a need for an improved device that eliminates the cumbersome nature of having to use multiple single-function tools.